Question

The patient's history for update purposes

Patient A age 70. He is obese and 100% sedentary. He needs to do physical exercises, to lose weight, to decrease stress and to eat better (but he does not do that). He has diabetes: 25 years ago, he was diagnosed with diabetes type 2 and he has to take insulin.

Diet: He eats meat 3 times a day and does not eat dietary fiber.

Emotional: He is stressed and anxious, and works hard.

Parents: The mother and father died young because of complications of diabetes. Father: died at age 53 of myocardial infarction.

Symptoms now: shortness of breath, chest pain due to physical exertion (angina).

Has high blood pressure: 140/90. Never had hypertension before. His doctor prescribed for hypertension: Vasotec (enalapril).

He must take the following exams:

FSC: red blood cells, white blood cells and platelets

Lipid profile

Creatinine test

Uremia test (urine in the blood)

Electrolytes test (usually sodium or potassium or an acid-base imbalance)

Clearance of creatinine test

HbA1c test (also called glycated hemoglobin test, and glycohemoglobin)

Stress ECG test

Urine analysis

3 weeks later, the results:

Clearance of creatinine test show to us the GFR (Glomerular Filtration Rate) results:
GFR 55mL/min (normal: 90-125mL/min)

Lipid profile: low level HDL, high level LDL

Plasma creatinine level (creatinine test): 150 mmol/L (normal: 50-110 umol/L)

Uremia test : 8 mmol/L (N : 3 - 6,5 mmol/L)

Urine analysis: 120 mg/L of proteins (normal: < 80 mg/L)

Stress ECG test: Anomalies related to unstable angina

Doctor's conclusion: chronic renal insufficiency (CRI), unstable angina. Needs to do an emergency angiography.

Angiography test results: several atheroma plaques in the coronary arteries. He had to put four stents during the procedure.

He had to take these medicaments:

Clopidogrel (Plavix), Aspirine (acide salicylique, for 1 year), and Crestor (is a statine). And also, the insulin and Vasotec (énalapril).

Question E: What is the link of diabetes with the liver and pancreas? And with the HbA1c? And with the liver and with coagulation, bile and vitamin K (if it causes low absorption of vitamin K)?

Answer 1

Liver role in diabetes:

Low Density Lipoproteins (LDL): It is a one type of cholesterol, which was produced in the liver. A high level of LDL can makes a plaque-like substance on the cardiovascular system walls and blocks blood natural flow and it leads to severe risk for stroke and heart attack. A high LDL levels can increase blood glucose level and causes diabetes. The liver can uptake LDL and convert it into HDL. If any prolonged increase in LDL levels can leads to diabetes.

LDL 152 mg/dl:

According to the given data the LDL (Low Density Lipoprotein) levels was present at 152 mg/dl and it is concerned as a borderline range.

Less than 100 mg/dL = Optimal
100-129 mg/dL = Near/Above Optimal
130-159 mg/dL = Borderline High
160-189 mg/dL = High
190 mg/dL and above = Very High

HbA1C is 7%:

The hemoglobin A1c test can provides average blood sugar levels over the past 2 to 3 months and it is also called as a glycohemoglobin, glycated hemoglobin test and HbA1c. The A1c test is also used to diagnose diabetes and a diabetes patients can do this test frequently because to see if their levels are staying within the range or high. By using this test we can adjust diabetes medicines.

Pancreas role in diabetes:

Diabetes is a metabolic disease it is mainly happens due to the high levels of glucose (blood sugar) in the blood or inadequate production of insulin.

Type II diabetes: It is happens due to the disorder in the metabolism characterized by elevated blood sugar levels, insulin resistance with symptoms of increased thirst (Polydipsia), urination (Polyuria), weight loss, tired, hunger (Polyphagia) etc. It mostly occurs in obese patients. Type 2 usually affects adults, but it can begin at any time in your life.

When the blood glucose levels are too high then B cells in the ilets of the langerhans, in the pancrease will secrete insulin. Insulin is a protein hormone that is secreted into the blood and make muscle cell absorbs more glucose. When the blood glucose levels are too low then a cells in the ilets of the langerhans, in the pancrease will secrete hormone glucagon. The high glucose levels of blood are antagonistically regulated by insulin and glucogon. Normal person’s glucose levels in blood are nearly demonstrated between 3.9 and 5.5 mmol/L (70 to 100 mg/dL). If the insulin levels are low or absent, then the glucose concentration in the plasma exceeds and the uncontrolled glucose concentration leads to many diseases.

Vitamin K role in diabetes:

Lower diabetes risk can associated with the greater intake of vitamin K. The vitamin K could lower diabetes risk via an influence on calcium metabolism, yet adjusting for calcium and vitamin D intake.